Skip to main content
SpringerLink
Log in

Diagnostic performance of CT for the detection of transmural bowel necrosis in non-occlusive mesenteric ischemia

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

A Correction to this article was published on 12 March 2021

This article has been updated

Abstract

Objectives

To evaluate the diagnostic performance of CT for transmural necrosis (TN) in non-occlusive mesenteric ischemia (NOMI) according to the bowel segment involved.

Methods

From January 2009 to December 2019, all patients admitted to the intensive care unit (ICU) and requiring laparotomy for NOMI were retrospectively studied. CT had to have been performed within 24 h prior to laparotomy and were reviewed by two abdominal radiologists, with a consensus reading in case of disagreement. A set of CT features of mesenteric ischemia were assessed, separating the stomach, jejunum, ileum, and right (RC) and left colon (LC). Univariate and multivariate analyses were performed to identify features associated with TN. Its influence on overall survival (OS) was assessed.

Results

Among 145 patients, 95 (66%) had ≥ 1 bowel segment with TN, including 7 (5%), 31 (21%), 43 (29%), 45 (31%), and 52 (35%) in the stomach, jejunum, ileum, RC, and LC, respectively. Overall inter-reader agreement of CT features was significantly lower in the colon than in the small bowel (0.59 [0.52–0.65] vs 0.74 [0.70–0.77] respectively). The absence of bowel wall enhancement was the only CT feature associated with TN by multivariate analysis, whatever the bowel segment involved. Proximal TN was associated with poorer OS (p < 0.001).

Conclusions

The absence of bowel wall enhancement remains the most consistent CT feature of transmural necrosis, whatever the bowel segment involved in NOMI. Inter-reader agreement of CT features is lower in the colon than in the small bowel. Proximal TN seems to be associated with poorer OS.

Key Points

• The absence of bowel wall enhancement is the most consistent CT feature associated with transmural necrosis in NOMI, whatever is the bowel segment involved.

• Inter-reader agreement is lower in the colon than in the small bowel in NOMI.

• In NOMI, the more proximal the bowel necrosis, the worse the prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Change history

Abbreviations

AMI:

Acute mesenteric infarction

ASAT:

Aspartate aminotransferase

AUC:

Area under the curve

CT:

Computed tomography

ICU:

Intensive care unit

LC:

Left colon

NAD:

Noradrenaline

NOMI:

Non-occlusive mesenteric ischemia

NPV:

negative predictive value

OMI:

Occlusive mesenteric ischemia

OS:

Overall survival

PPV:

positive predictive value

RC:

Right colon

References

  1. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM (2004) Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 91:17–27. https://doi.org/10.1002/bjs.4459

  2. Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P (2002) Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol 12:1179–1187. https://doi.org/10.1007/s00330-001-1220-2

  3. Pérez-García C, de Miguel CE, Fernández Gonzalo A et al (2018) Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery. Br J Radiol 91:20170492. https://doi.org/10.1259/bjr.20170492

    Article  PubMed  Google Scholar 

  4. Gnanapandithan K, Feuerstadt P (2020) Review article: mesenteric ischemia. Curr Gastroenterol Rep 22:17. https://doi.org/10.1007/s11894-020-0754-x

    Article  PubMed  Google Scholar 

  5. Nuzzo A, Maggiori L, Ronot M et al (2017) Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol 112:597–605. https://doi.org/10.1038/ajg.2017.38

    Article  PubMed  Google Scholar 

  6. Kammerer S, Schuelke C, Berkemeyer S et al (2018) The role of multislice computed tomography (MSCT) angiography in the diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI): Could MSCT replace DSA in diagnosis? PLoS One 13:e0193698. https://doi.org/10.1371/journal.pone.0193698

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Menke J (2010) Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 256:93–101. https://doi.org/10.1148/radiol.10091938

    Article  PubMed  Google Scholar 

  8. Atre ID, Eurboonyanun K, O’Shea A et al (2020) Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography. Abdom Radiol (NY). https://doi.org/10.1007/s00261-020-02558-8

  9. Emile SH (2018) Predictive factors for intestinal transmural necrosis in patients with acute mesenteric ischemia. World J Surg 42:2364–2372. https://doi.org/10.1007/s00268-018-4503-3

    Article  PubMed  Google Scholar 

  10. Emile SH, Khan SM, Barsoum SH (2020) Predictors of bowel necrosis in patients with acute mesenteric ischemia: systematic review and meta-analysis. Updates Surg. https://doi.org/10.1007/s13304-020-00857-9

  11. Calame P, Malakhia A, Turco C, Grillet F, Piton G, Delabrousse E (2019) Transmural bowel necrosis from acute mesenteric ischemia and strangulated small-bowel obstruction: distinctive CT features. AJR Am J Roentgenol 214:90–95. https://doi.org/10.2214/AJR.19.21693

  12. Rondenet C, Millet I, Corno L, Boulay-Coletta I, Taourel P, Zins M (2018) Increased unenhanced bowel-wall attenuation: a specific sign of bowel necrosis in closed-loop small-bowel obstruction. Eur Radiol 28:4225–4233. https://doi.org/10.1007/s00330-018-5402-6

  13. Kanasaki S, Furukawa A, Fumoto K et al (2018) Acute mesenteric ischemia: multidetector CT findings and endovascular management. Radiographics 38:945–961. https://doi.org/10.1148/rg.2018170163

    Article  PubMed  Google Scholar 

  14. Millet I, Taourel P, Ruyer A, Molinari N (2015) Value of CT findings to predict surgical ischemia in small bowel obstruction: a systematic review and meta-analysis. Eur Radiol 25:1823–1835. https://doi.org/10.1007/s00330-014-3440-2

    Article  PubMed  Google Scholar 

  15. Copin P, Zins M, Nuzzo A et al (2018) Acute mesenteric ischemia: a critical role for the radiologist. Diagn Interv Imaging 99:123–134. https://doi.org/10.1016/j.diii.2018.01.004

    Article  CAS  PubMed  Google Scholar 

  16. Garzelli L, Nuzzo A, Copin P et al (2020) Contrast-enhanced CT for the diagnosis of acute mesenteric ischemia. AJR Am J Roentgenol 1–10. https://doi.org/10.2214/AJR.19.22625

  17. Madl C, Druml W (2003) Gastrointestinal disorders of the critically ill. Systemic consequences of ileus. Best Pract Res Clin Gastroenterol 17:445–456. https://doi.org/10.1016/s1521-6918(03)00022-2

    Article  PubMed  Google Scholar 

  18. Atre ID, Eurboonyanun K, O’Shea A et al (2020) Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography. Abdom Radiol (NY). https://doi.org/10.1007/s00261-020-02558-8

  19. Barrett T, Upponi S, Benaglia T, Tasker AD (2013) Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery. Br J Radiol 86. https://doi.org/10.1259/bjr.20130277

  20. Canfora A, Ferronetti A, Marte G et al (2019) Predictive Factors of Intestinal Necrosis in Acute Mesenteric Ischemia. Open Med (Wars) 14:883–889. https://doi.org/10.1515/med-2019-0104

    Article  Google Scholar 

  21. Bourcier S, Oudjit A, Goudard G et al (2016) Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit. Ann Intensive Care 6:112. https://doi.org/10.1186/s13613-016-0213-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wong Y-C, Wu C-H, Wang L-J, Chen H-W, Lin B-C, Huang C-C (2013) Mesenteric vascular occlusion: comparison of ancillary CT findings between arterial and venous occlusions and independent CT findings suggesting life-threatening events. Korean J Radiol 14:38–44. https://doi.org/10.3348/kjr.2013.14.1.38

  23. Copin P, Ronot M, Nuzzo A et al (2018) Inter-reader agreement of CT features of acute mesenteric ischemia. Eur J Radiol 105:87–95. https://doi.org/10.1016/j.ejrad.2018.05.027

    Article  PubMed  Google Scholar 

  24. Chuong AM, Corno L, Beaussier H et al (2016) Assessment of bowel wall enhancement for the diagnosis of intestinal ischemia in patients with small bowel obstruction: value of adding unenhanced CT to contrast-enhanced CT. Radiology 280:98–107. https://doi.org/10.1148/radiol.2016151029

    Article  PubMed  Google Scholar 

  25. Mazzei MA, Volterrani L (2015) Nonocclusive mesenteric ischaemia: think about it. Radiol Med 120:85–95. https://doi.org/10.1007/s11547-014-0460-6

    Article  PubMed  Google Scholar 

  26. Horton KM, Fishman EK (2001) Multi–detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473. https://doi.org/10.1148/radiographics.21.6.g01nv091463

    Article  CAS  PubMed  Google Scholar 

  27. Guillaume A, Pili-Floury S, Chocron S et al (2017) Acute mesenteric ischemia among postcardiac surgery patients presenting with multiple organ failure. Shock 47:296–302. https://doi.org/10.1097/SHK.0000000000000720

    Article  PubMed  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France

    Pierre Verdot, Paul Calame, Franck Grillet, Alexandre Malakhia & Eric Delabrousse

  2. EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France

    Paul Calame & Eric Delabrousse

  3. Medical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France

    Hadrien Winiszewski & Gael Piton

  4. Digestive Surgery Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France

    Zaher Lakkis

  5. Department of Radiology, Hôpital Beaujon, APHP.Nord,Université de Paris, 92110, Clichy, France

    Maxime Ronot

  6. Surgical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France

    Sebastien Pili-Floury

Authors
  1. Pierre Verdot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Calame
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hadrien Winiszewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franck Grillet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexandre Malakhia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zaher Lakkis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maxime Ronot
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sebastien Pili-Floury
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gael Piton
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eric Delabrousse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Calame.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Eric Delabrousse.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (Paul Calame).

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Paul Calame is affiliated with two institutions.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Verdot, P., Calame, P., Winiszewski, H. et al. Diagnostic performance of CT for the detection of transmural bowel necrosis in non-occlusive mesenteric ischemia. Eur Radiol 31, 6835–6845 (2021). https://doi.org/10.1007/s00330-021-07728-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-07728-w

Keywords

Search

Navigation